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NOTE: PULL ALL,,IRMITS (Septic, Well, etc.) MAKE ,.PIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004689 <br /> DATE RECEIVED by EHD: November 02,2004 APPL#: PA-04-650(PA) Pre-Application <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2691 <br /> GEN PLAN AMENDMENT 10+acres(GP) <br /> COMPLETE&SUBMIT BY: Wed, November 10, 2004 <br /> Assigned to : EE0000149 BORGES <br /> SITE ADDRESS: 2611 E LIBERTY RD, GALT APN : 00502016 <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e., sewage disposal, water <br /> supplies, etc...). Where necessary, on an attached piece of plain paper, draw complete map of area showing population <br /> density, location of house, wind direction, etc.... <br /> Public Water: Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: ( a $ p <br /> I recommend: Approval ❑ Denial El Continuance El Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 Check OH List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)?- Logged in LAND USE Book? <br /> EH 06 06 Report#9201 Page i November 04,2004 <br />